101. Definitive hyperfractionated, accelerated proton reirradiation for patients with pelvic malignancies
- Author
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Emma B. Holliday, Praveen Polamraju, Eugene J. Koay, Sunil Krishnan, Bruce D. Minsky, Albert C. Koong, Grace L. Smith, Ethan B. Ludmir, Shalini Moningi, Joseph D. Herman, Prajnan Das, Cullen M. Taniguchi, Marcella M. Melkun, and Tyler D. Williamson
- Subjects
Colorectal cancer ,Recurrent cancer ,R895-920 ,Proton re-irradiation ,Proton beam radiation ,Article ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Medical physics. Medical radiology. Nuclear medicine ,0302 clinical medicine ,medicine ,Relative biological effectiveness ,Anal cancer ,Radiology, Nuclear Medicine and imaging ,Progression-free survival ,Rectal cancer ,Pelvis ,Survival analysis ,RC254-282 ,business.industry ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,medicine.disease ,body regions ,medicine.anatomical_structure ,Oncology ,030220 oncology & carcinogenesis ,Bone marrow ,Nuclear medicine ,business - Abstract
Highlights • Proton pelvic reirradiation results in lower bone marrow dose compared to photons. • Proton pelvic reirradiation of the pelvis is well tolerated with limited toxicities., Introduction Pelvic reirradiation (re-RT) presents challenges due to concerns for late toxicity to tissues-at-risk including pelvic bone marrow (PBM). We routinely utilize a hyperfractionated, accelerated re-RT for recurrent rectal or anal cancer in the setting of prior radiation. We hypothesized that proton beam radiation (PBR) is uniquely suited to limit doses to pelvic non-target tissues better than photon-based approaches. Materials and methods All patients who received hyperfractionated, accelerated PBR re-RT to the pelvis from 2007 to 2017 were identified. Re-RT was delivered twice daily with a 6 h minimum interfraction interval at 1.5 Gray Relative Biological Effectiveness (Gy(RBE)) per fraction to a total dose of 39–45 Gy(RBE). Concurrent chemotherapy was given to all patients. Comparison photon plans were generated for dosimetric analysis. Dosimetric parameters compared using a matched-pair analysis and the Wilcoxon signed-rank test. Survival analysis was performed Kaplan Meier curves. Results Fifteen patients were identified, with a median prior pelvic RT dose of 50.4 Gy (range 25–80 Gy). Median time between the initial RT and PBRT re-RT was 4.7 years (range 1.0–36.1 years). In comparison to corresponding photon re-RT plans, PBR re-RT plans had lower mean PBM dose, and lower volume of PBM getting 5 Gy, 10 Gy, 20 Gy, and 30 Gy (p
- Published
- 2019